Surgical instrument for treating female urinary stress incontinence

ABSTRACT

A suburethral sling device and method for treating female urinary stress incontinence which is anatomically configured to implant into the lower abdomen of a female in a manner providing support to mid-urethral and bladder neck sphincteric continence sites with the sling defining in part, mesh and tissue remodeling portions. The sling is deployed via a sling transfer instrument having distal and proximal ends with the instrument comprising in part a progressively curved shaft portion positioned between the distal and proximal ends. An insertion handle of the transfer instrument is secured to the curved metal shaft section guiding the shaft tip through the tissues of the abdomen in an anterior/posterior direction as well as a cephalad/caudad direction.

CROSS-REFERENCE TO PENDING APPLICATIONS

The pending application is a continuation-in-part application of U.S.patent application Ser. No. 10/308,735 entitled “A Surgical InstrumentFor Treating Female Urinary Stress Incontinence” filed on Dec. 3, 2002.

TECHNICAL FIELD OF THE INVENTION

The present invention relates to surgical instruments for treatingfemale urinary stress incontinence problems generally and in particular,a suburethral, anatomically configured mesh sling for implanting intothe lower abdomen of a female which provides simultaneous support tomid-urethral and bladder neck sphincteric continence sites.

BACKGROUND OF THE INVENTION

The suburethral sling technique for treatment of stress urinaryincontinence has become the preferred treatment because the long termresults are better in most cases than other treatment methods. Theclassic pubovaginal sling technique utilizes rectus fascia from thepatient as the sling material for support of the urethra. The morbidityof rectus fascia pubovaginal sling procedures has caused surgeons toutilize alternative materials. Permanent non-absorbable materials havebeen deployed in one such alternative but have resulted in erosions ofthe synthetic material into the urethra and vagina. Also, infections ofthe sling have had serious complications because of the material beingtreated as a “foreign body”.

Cadaveric tissue has been used in an effort to avoid the problem of“foreign body” reactions resulting in infections and erosions. However,cadaveric fascia and cadaveric dermis have not had the same results astissue derived from the patient at the time of surgery. Cadaveric fasciais a tissue remodeling material. That is, the human body recognizes thetissue as a familiar material and biochemically breaks down the tissueand rebuilds it as its own tissue. Unfortunately, during the breakingdown period of the cadaveric tissue, the tissue strength often failsrendering support of the urethra inadequate. Consequently, the urethra“falls” back down and the sling fails. Remodeling tissue needs to haveadditional strength during the time of remodeling in order to avoidfailure of the material due to material weakness. Once remodeling hasoccurred, the tissue is strong enough to provide a good result for along time.

Biodegradable materials such as polylactate are available that aredegraded by the body slowly over 18 months to 30 months. These materialscan be made into a mesh to support the tissue remodeling materialsthrough the period of remodeling. This leaves normal body tissuesupporting the urethra that has resulted from the remodeling process.The biodegradable sling material such as polylactate is absorbed by thebody and there is no “foreign body” to create erosions and infections.

Deployment of the current sling devices utilize complicated slingtransfer instruments that cannot be well controlled by the surgeon. Thishas resulted in serious complications including perforation of bowel aswell as injury to major arteries and veins causing death in young womenwho are otherwise healthy having a simple surgical procedure. It iscritical that the sling transfer instrument be simplified and bettercontrol of the instrument be provided to the surgeon.

As the urethra prolapses or “falls down” resulting in loss of bladdercontrol, the entire vaginal wall also prolapses or “falls down”. Currentsling procedures do not provide any support for the anterior vaginalwall. One of the most common causes of re-operation after current slingprocedures is a cystocele repair to repair the anterior vaginal prolapsethat should progressively worsened after the sling placement. Currentslings are not designed to repair the anterior vaginal wall at the sametime the support of the urethra is done. A sling is needed that supportsthe entire functional urethra as well as the base of the bladder toprevent progression of vaginal prolapse.

The normal woman when in the standing has the urethra in a position thatthe axis through the urethra is 15 degrees to 35 degrees off a truevertical position. The pubic bone has an axis of about 45 degrees off atrue vertical position. This makes the angle or the axis of the pubisand the angle of the axis of the urethra about 70 degrees to 90 degrees.The base of the bladder as it attaches to the urethra has a posteriorangle of 90 degrees to 115 degrees. The contoured sling is designed torestore the urethro-vesical angle and to restore the axis of theurethra.

Deployment of contemporary sling devices utilize complicated slingtransfer instruments that cannot be well controlled by the surgeon. Thishas resulted in serious complications including perforation of bowel aswell as injury to major arteries and veins causing death in young womenwho are otherwise healthy having a simple surgical procedure. In keepingwith the teachings of the instant invention, it is critical that a slingtransfer instrument be simplified to allow enhanced instrument controlby the surgeon.

Given the deficiencies of the contemporary art and the enhancementteachings of the instant invention, it is an object of the instantinvention to provide a tubular mesh sling for incontinence whicheliminates urethral obstruction and voiding difficulties associated withslings and tapes of the contemporary art.

It is another object of the instant invention to provide an incontinencesolution which avoids the morbidity associated with rectus fascia tissuetransplanted from the abdomen to the vagina of a patient and the longterm durability deficiencies of cadaveric tissue as used in thecontemporary art.

It is a further object of the instant invention to provide anincontinence solution which avoids the numerous and seriouscomplications from intra-operative injury to organs in the pelvis.

It is yet another object of the instant invention to avoid paravaginaldissection required of surgical instruments and methodologies associatedwith the contemporary art.

A further object of the instant invention is to provide an incontinencesolution which is embodied as a sling design conforming to theanatomical variations of the urethra of women who have urinaryincontinence.

A yet further object of the instant invention is to provide a knit meshpubovaginal sling which conforms to the anatomy of the urethra andanterior vaginal wall when the anatomy of a patient is distorted byurethral prolapse or previous vaginal surgery.

Another object of the instant invention is to present a mesh slingembodiment in a component structure that has an anterior surface whichattaches to the vaginal wall adjacent to the urethra and a posteriorsurface which attaches to the vaginal mucosa.

An additional object of the instant invention is to provide anincontinence solution in a mesh sling form which avoids buckling due toopposing forces of the vaginal wall and vaginal mucosa on the sling.

A further object of the instant invention is to provide a mesh slingwhich has an anterior and posterioral layer which provides greatertensile strength compared to tape mesh slings of the contemporary art.

Yet another object of the instant invention is to provide a mesh slingdesign which demonstrates a significant degree of elasticity of thesling material.

A further object of the instant invention is to provide a tubular meshsling which embodies a dual continence design and can be positioned tosupport both the mid-urethra and bladder neck sphincteric continencesites.

Another object of the instant invention is to provide a sling comprisedin part of tissue remodeling material where sufficient support isprovided to tissue remodeling material during biochemical breakdown ofthe tissue and rebuilding.

Another object of the instant invention is to provide a sling which iscomprised of biodegradable materials and tissue remodeling materials.

A further object of the present invention is to disclose and teach asling transfer instrument which allows enhanced sling deployment controlby a surgeon.

Another object of the instant invention is to teach a method andapparatus for sling deployment utilizing either suprapubic, transvaginalor obturator fossa deployment methodologies.

A further object of the instant invention is an anterior vaginal slingthat restores anatomical support to both the mid-urethral continencesphincteric function and the bladder neck continence sphinctericfunction.

Another object of the instant invention is an anterior vaginal slingthat restores the anatomical relationship of the urinary bladder to theurethral by providing confluent support to the base of the bladder andthe proximal urethra.

A further object of the instant invention includes an anterior vaginalsling that is contoured to restore the normal anatomical position of themid-urethra, the proximal urethra, the bladder neck, and the base of thebladder which not only restores the normal continence sphinctericfunction of the urethra but also restores normal bladder functionrelative to the urethra.

Yet another object of the invention provides an anterior vaginal slingcomposed of biodegradable mesh or non-biodegradable mesh in anynon-proprietary weave configuration.

An object of the instant invention provides an anterior vaginal slingdesign using biodegradable mesh reinforced tissue remodeling materialwith the biodegradable mesh combined with tissue remodeling material toprovide tensile strength for the tissue remodeling material during aninterval of tissue weakness due to the process of remodeling. Thebiodegradable material can be layered, stranded, or randomly combinedwith tissue remodeling materials.

Still yet, another object of the instant invention provides a slingtransfer instrument that has a progressively curved shaft portion and asharply curved tip that allows the instrument to be passed through theretropubic space with a reduced risk of organ perforation.

Further, an object of the instant invention provides the sling hassupporting ribs throughout the distal part of each end of the sling tosecure the sling to surrounding tissues and to allow for sling tensionadjustment.

Another object of the instant invention includes a biodegradable tabwhich is located at the middle of the sling and extends through thevaginal mucosa postoperatively to allow loosening of the sling tensionpostoperatively if necessary.

A further object of the instant invention provides that the distalsegment of each end of the sling is left in place postoperatively toallow tightening of sling tension if necessary. An attachable handle isused postoperatively for sling tension adjustment.

Yet another object of the present invention provides a spring designsling tension adjustment instrument that is used intra operatively toinsure proper sling tension.

A further object of the present invention provides an extendedembodiment of the sling that is used to provide support to the proximalsegment of the anterior vagina to support cystocele repair.

An additional object of the present invention provide that the slingtransfer instruments are designed with a luminous coating for easyidentification during cystoscopy should perforation of the bladderoccur.

Another object of the present invention is to provide a sling transferinstrument with detachable insertion handle designed to provide maximumcontrol to the surgeon of the instrument tip to avoid organ perforation.Finger grips and a specially designed thumb control feature of thehandle provides accuracy of tip placement.

An alternative object of the present invention provides that theembodiment of the sling transfer instrument design is used for placementfrom a suprapubic position through the prevesical space into the vagina.The sling is attached to the tip of the instrument and transferred tothe suprapubic position.

SUMMARY OF THE INVENTION

The pubovaginal sling of the instant invention is a tubular layeredsling configuration. A mesh comprised of a biodegradable polymer such aspolylactate is placed around a layer of tissue remodeling material suchas cadaveric fascia to form a tubular layered sling configuration. Thebiodegradable polymer segment of the sling provides tensile strength tothe tissue remodeling material throughout the remodeling period untilthe remodeled tissue has achieved maximum tensile strength. After theremodeled tissue has formed, the biodegradable polymer will begin tolose tensile strength and disappear through biodegradation, leavingnormal body tissue from the remodeled material in position to supportthe anterior vaginal wall and urethra without “falling down” duringtissue remodeling when the remodeling material is weakened by theremodeling process of the body. The layered sling configuration can beconstructed with the tissue remodeling material layered between twolayers of biodegradable material in a tubular configuration. The tubularsling may be configured from multiple layers of a single biodegradablematerial or it can be configured using multiple layers of differentbiodegradable materials. Multiple layers of a single tissue remodelingmaterial may be used or multiple layers of different remodelingmaterials may be used.

An embodiment of the tubular layered sling configuration includes acentral tubular configuration of biodegradable mesh surrounded by atubular sling comprised of tissue remodeling material. An alternativeembodiment includes a non-biodegradable tubular mesh sling that can beplaced between layers of tissue remodeling materials. An alternativeembodiment includes a tubular mesh sling that has a central segment thatis non-biodegradable with a distal segment that is biodegradable.Finally, an essential embodiment of the tubular sling design includestubular distal segments with a layered non-tubular central segment.

The layered tubular sling configuration of the instant invention has aunique design that is contoured to the anatomical configuration of themid-urethra, the proximal urethra, and the base of the bladder. Thecontoured sling restores the normal anatomical relationship between theurethra and the bladder. Restoring the normal anatomical relationship ofthe urethra to the urinary bladder results not only in urinarycontinence but also enables normal voiding to occur following theoperative procedure. Urinary continence is only part of the desiredsurgical outcome, however normal voiding following surgery is equallyimportant as urinary continence for surgical management of incontinencein women.

Slings of the contemporary art are often represented as a “tape” slingand do not restore the normal anatomical relationship of the urinarybladder to the urethra. The contoured tubular sling is shaped to restorethe normal anatomy of the urethra and the base of the bladder. Therestoration of the normal anatomical position of the urethra relative tothe urinary bladder is critical for normal voiding followingincontinence surgery. One of the most common problems followingincontinence surgery using tape slings is bladder obstruction due to anabnormal anatomical relationship between the bladder and the urethra.The contoured tubular sling avoids the anatomical obstruction from thecurrent “tape” slings by providing support for the urethra and bladderwith the normal anatomical contour. In the instant invention, the normalanatomical position is restored not only of the urethra but also thebase of the bladder. The most critical objective that must beaccomplished is restoration of the anatomical relationship between theurethra and the bladder in order for normal voiding to occur aftersurgery.

Voiding dysfunctions including urinary frequency, urinary urgency, andnocturia are common problems after current sling procedures because thenormal anatomical relationship between the urethra and the bladder isnot restored. The focus of treatment of stress urinary incontinence inwomen has been the urethra alone with methods to support the urethra toprevent incontinence with coughing or sneezing. The anatomicalrelationship of the urethra to the bladder has not been maintained with“tape slings” and the result has been postoperative voidingdysfunctions. The contoured tubular sling provides support to thefunctional urethral which is the mid-urethra, the proximal urethra andthe bladder neck. In addition, the contoured tubular sling providessupport to the base of the bladder which prevents voiding dysfunctionsin women following surgery.

An alternative embodiment of the contoured tubular sling using thelayered sling configuration design is “extended support” of the anteriorvaginal wall to include the entire anterior vaginal wall. This “extendedsupport” provides surgical management of cystocele repair in combinationwith incontinence surgery. The “extended support” design has eyelets forsuture placement or tissue anchor placement to secure the vaginalsupport segment of the tubular sling in position. An alternativeembodiment of the “extended support” design of the layered slingconfiguration includes segments of different size and shape that arerequired to support vaginal vault repair including cystocele repair,enterocele repair, and rectocele repair.

The distal segments of the layered tubular sling configuration isapproximately 1 centimeter in width and has small “ribs” that passtransversely through the sling to secure the sling in position. The“rib” design eliminates the need for the plastic sheath of currentslings. The plastic sheath of current slings is difficult to remove andexcess sling tension is often a complication of intra operative sheathremoval.

The sling tension is adjusted using a spring loaded sling tensionadjustment device. The sling tension adjustment device is designed toavoid the problem of the sling being placed with too much tension aroundthe urethra which results in urinary retention following surgery. Duringthe surgical procedure, the sling is tightened until the spring iscompressed and the sling tension device is closed which results inappropriate sling tension.

The “confluent” sling transfer instrument is a unique design that ispassed from the vagina through the retropubic space. The tip of thetransfer instrument has a reverse curve shape that keeps the tip inimmediate contact with the pubic bone during placement of the instrumentwhich avoids injury to the bladder, adjacent bowel or major arteries andveins. The preferred shape of the confluent sling transfer instrument issquare with rounded corners. Alternative embodiments include oval shapeand rectangular shape. The diameter of the curvature of the instrumentis approximately 23.5 cm with a radius of approximately 8 cm. Theproximal 6 cm of the instrument is straight and inserts into a handle.The handle is detachable which allows the sling transfer instrument tobe passed from a transvaginal position to the suprapubic area on boththe right and left side. A transfer handle is attached on the tip of theinstrument in the suprapubic area and the insertion handle is detachedto allow attachment of the sling. This allows the sling transferinstrument to be inserted transvaginally and passed through theretropubic space, the tip in the suprapubic area is then controlled byan attachable transfer handle, the insertion handle is detached, thesling is attached to the base of the instrument where the insertionhandle was located, and the sling transfer instrument is pulled throughthe retropubic space in a single pass with a confluent motion. Once thesling is positioned in the suprapubic position, the sling is cut nearthe tip and the sling transfer instrument is removed on both the rightand left side.

After the sling transfer instrument is passed through the retropubicspace, cystoscopy is done to insure that the instrument did notinadvertently pass through the urinary bladder. Since it is difficult tosee a gray colored metal transfer instrument on endoscopic examinationof the bladder, the confluent sling transfer instrument is covered witha luminous material to allow it to be easily identified endoscopically.The “luminous” feature of the confluent sling transfer instrumentreduces the risk of unrecognized bladder perforation by the slingtransfer instrument because it can be seen more easily on endoscopicexamination of the bladder. Such luminous materials include but are notlimited to fluorescent dyes, paints and coatings.

The handle of the instrument is a critical feature of control of theinstrument by the surgeon. The insertion handle is critical indetermining the retropubic path of the instrument during passing of theinstrument. The handle used is the same design described previouslywhich allows the surgeon to precisely guide the tip of the slingtransfer instrument against the pubic bone through the retropubic spaceduring placement of the instrument which prevents injury to bowel,bladder, and major arteries. The size and shape of the handle allow thesurgeon to have maximum control of the reverse curve tip of theinstrument which is positioned against the pubic bone at all timesduring placement which avoids injuries from the instrument.

When the transvaginal approach to placement of the contoured design ofthe layered tubular sling configuration is done, the confluent slingtransfer instrument is passed from the vagina through the retropubicspace. The thumb control of the introducing handle is used to maintainthe reverse curve tip of the confluent sling transfer instrumentdirectly in contact with the pubic bone throughout the retropubicplacement of the instrument. When the tip of the confluent transferinstrument exits the skin in the suprapubic area, the transfer handle isattached to the tip of the instrument and cystoscopy is performed toinsure that the sling transfer instrument did not pass through thebladder. With the transfer handle on the tip of the confluent transferinstrument to stabilize the instrument in position, the thumb controlledintroducing handle is disengaged from the proximal end of the instrumentand removed. The sling attachment tip is placed on the proximal end ofthe instrument where the thumb control handle was located, and thetransfer handle that has been placed on the distal tip of the instrumentis used to pull the confluent sling transfer instrument through theretropubic space along with the sling attachment tip and the distal endof the sling. The sling tension adjustment spring device is placedbetween the sling and the anterior vaginal wall. When the spring iscompressed, the sling adjustment device is removed. The excess slinglength in the suprapubic area is cut at the skin level.

In women who have complicated incontinence such as failed previoussurgery, the excess sling is cut 3 cm above the skin level. Anantibiotic dressing is used to cover the ends of the sling. Atapproximately three days following surgery, the dressing is removed andsling tension is adjusted. Sling tension is increased by placing thesling adjustment handles on the excess sling material in the suprapubicarea and applying increased tension to the sling along the anteriorvaginal wall. When sling tension has been adjusted to the desired level,the excess sling material is removed. When sling tension is too tight,the sling adjustment tab in the vagina is grasp with an instrument andthe sling tension is reduced by applying downward tension. The slingtension postoperatively is adjusted based on the clinical ability of thepatient to void. When ideal sling tension is achieved, the slingadjustment tab in the vagina is cut at the vaginal mucosa level. Also,the ends of the sling in the suprapubic area are cut at the skin level.

It is to be understood that both the foregoing general description andthe following detailed description are exemplary and explanatory only,and are not restrictive of the invention as claimed. The accompanyingdrawings, which are incorporated herein by reference, and whichconstitute a part of this specification, illustrate certain embodimentsof the invention and, together with the detailed description, serve toexplain the principles of the present invention.

Further, the purpose of the foregoing abstract is to enable the U.S.Patent and Trademark Office and the public generally, and especially thedesign engineers and practitioners in the art who are not familiar withpatent or legal terms or phraseology, to determine quickly from acursory inspection the nature and essence of the technical disclosure ofthe application. The abstract is neither intended to define theinvention of the application, which is measured by the claims, nor is itintended to be limiting as to the scope of the invention in any way.

In this respect, before explaining at least one embodiment of theinvention in detail, it is to be understood that the invention is notlimited in this application to the details of construction and to thearrangement so the components set forth in the following description orillustrated in the drawings. The invention is capable of otherembodiments and of being practiced and carried out in various ways.Also, it is to be understood that the phraseology and terminologyemployed herein are for the purpose of description and should not beregarded as limiting. As such, those skilled in the art will appreciatethat the conception, upon which this disclosure is based, may readily beutilized as a basis for the designing of other structures, methods andsystems for carrying out the several purposes of the present invention.It is important, therefore that the claims be regarded as including suchequivalent constructions insofar as they do not depart from the spiritand scope of the present invention.

DESCRIPTION OF THE DRAWINGS

FIGS. 1 through 1B illustrate the mesh sling of the instant inventiondistinguishing further its tubular mesh and tissue remodeling materialcomponents.

FIGS. 2 through 2A illustrate the mesh sling of the instant inventionwherein tubular mesh and tissue remodeling materials have beenstructured and presented in an alternative structural relationship thanthat disclosed in FIGS. 1 through 1B.

FIG. 3 is an illustration of the tubular sling of the instant inventionproviding further details with respect to its anatomical contoureddesign.

FIG. 3A is an illustration of the sling of FIG. 3 providing furtherdetail with respect to the center most position of the tubular sling andits tissue remodeling material component.

FIG. 4 is an illustration of the tubular sling of the instant inventionas positioned to anatomically support mid-urethra and bladder necksphincteric continence sites as well as the base of the bladder.

FIGS. 5 through 5B are illustrations of the sling transfer instrumenttool as used in transvaginal and suprapubic deployment methodologies.

FIG. 6 is an illustration of sling transfer tool as used in obturatorfossa deployment embodiments.

FIGS. 7 and 8 illustrate alternative embodiments of the tubular sling ofthe instant invention as deployed in extended continence supportapplications.

FIG. 9 is an illustration of the sling tension tab of the instantinvention for decreasing tension providing further detail to allow forproper sling tension subsequent to deployment and positioning.

FIG. 10 is an illustration of the sling tension adjustment handle of theinstant invention for increasing tension providing further detail toallow for proper sling tension subsequent to deployment and positioning.

DESCRIPTION OF THE PREFERRED EMBODIMENT

While the making and using of various embodiments of the presentinvention are discussed in detail below, it should be appreciated thatthe present invention provides for inventive concepts capable of beingembodied in a variety of specific contexts. The specific embodimentsdiscussed herein are merely illustrative of specific manners in which tomake and use the invention and are not to be interpreted as limiting thescope of the instant invention.

FIGS. 1 through 1B illustrate the mesh sling of the instant inventiondistinguishing further its tubular mesh and tissue remodeling materialcomponents. Turning now to FIG. 1 through 1B. In FIG. 1 it may beobserved where the mesh sling is generally referred to as element 3 andis comprised of a generally central segment 5 and distal segments 7 and8. The central segment 5 of the tubular mesh sling 3 is approximately2.5 cm wide and 4.0 cm long with a rapid taper over approximately 1.5 cmdown to a size of 1.0 cm in width at distal ends 7 and 8. Each distalsection 7 and 8 may be covered with a circular plastic sheath whichextends and overlaps in the central segment 5. The plastic sheath(s) areremoved at the end of the sling's deployment procedure. Though variableand appropriate dimensions may be had with respect to the sling of theinstant invention, the sling's deployment is most effective whenpracticed at an approximate length of 60 cm and 4.0 cm central sectionto position and support the bladder neck sphincteric and mid-urethralsphincteric sites as well as support for the base of the bladder.

FIG. 1B is a cross-sectional view of the sling of FIG. 1 illustratingrelative positioning of tissue remodeling material 10, the sling'scenter most portion and mesh portions 11 and 12 substantiallysurrounding/sandwiching to tissue remodeling portion 10. Said tissueremodeling portion 10 and mesh portions 11 and 12 are bonded orotherwise fixedly attached to one another by surgical adhesive means orsuturing means well known to skilled practitioners of the art.

FIG. 1C illustrates a partial sectionalize view of the distal segments 7or 8 wherein tubular mesh sections are again defined as elements 11 and12 and substantially surround tissue remodeling material 10. Varioustissue remodeling materials may be used with respect to practicing thesling of the instant invention including homologous tissues andheterologous tissues. The mesh portions of the sling of the instantinvention 11 and 12 are non-limitedly comprised of non-absorbablepolymers, such as polypropylene, and possess a filament size ofapproximately 0.006 of an inch. Biodegradable mesh portions arenon-limitedly, absorbable polymers, such as polylactate with a filamentsize of approximately 0.015 of an inch. To those skilled in the art itwill become readily apparent that for rapidly absorbable bio-polymers alarger filament size can and should be practiced. As disclosed in theparent application, a combination of filament patterns may be used torepresent the knit pattern such as but not limited to a simple knit, acomplex knit, or woven pattern. The knit pattern may have seams or beseamless and with the size of the filaments dependent upon the clinicalapplication may be simple knit, complex knit, or woven pattern and suchknit patterns may have seams or be seamless. The size of the filament isdependent upon the clinical application and chemical composition of theknit. The center segment may be a non-absorbable material withabsorbable distal segments which provides a permanent support around theurethra and bladder neck while the retro pubic segment is absorbable anddisappears over time.

FIGS. 2 through 2A illustrate a readily envisioned alternativeembodiment of the instant invention wherein the center most section 5has been replaced with an alternative positioning structure of meshmaterials 11 and 12 and tissue remodeling material 10. Statedsuccinctly, the mesh sling of FIGS. 2 and 2A comprises a center mostposition wherein tissue remodeling material 10 substantially surroundsand sandwiches mesh section 11. Further clarification with respect tothe non-limiting alternative embodiment illustrated in FIG. 2 will bepresented in conjunction with discussion of FIG. 3A.

FIG. 3 is an illustration of the tubular sling of the instant inventionproviding further details with respect to its anatomical contoureddesign. Turning now to FIG. 3.

In FIG. 3 it is seen where the tubular mesh distal sections 8 and 9attach in a graduating manner to contoured sling center most section 5wherein center most section 5 as disclosed in FIG. 3 is contoured tosupport both mid-urethral and bladder neck sphincteric continence sitesas will be discussed further in association with FIG. 4. FIG. 3illustrates further the positional structuring of tubular mesh andtissue remodeling materials as discussed in association with FIGS. 1through 1B. The normal anatomical relationship between the bladder andurethra is restored by additional support to the base of the bladder.

FIG. 3A provides greater specificity and illustrates the positionalstructures of mesh and tissue remodeling material as presented inassociated with discussion of FIGS. 2 and 2A wherein distal ends 8 and 9are shown presenting a tubular mesh sector (innermost presentation notdisclosed in FIG. 3A) and where the center most section of the contouredsling 5 is illustrated as comprising tissue remodeling material 11 tosandwich or otherwise encase tubular mesh section at contoured slingsection's 5 center most portion. The mesh of the center portion 5 may becomposed of the same material as the distal segment 8, 9 or the meshmaterial 5 may be different from 8, 9 including, but not limited to,biodegradable material combined with non-biodegradable material.

FIG. 4 is an illustration of the tubular sling of the instant inventionas positioned to anatomically support mid-urethra and bladder necksphincteric continence sites as well as the base of the bladder torestore the normal anatomical relationship of the bladder to theurethra. Turning now to FIG. 4.

In FIG. 4 it is observed where the contoured sling of the instantinvention 5 is shown properly positioned to support bladder 20 andurethra 21 sphincteric continence sites respectively labeled 22 themid-urethral continence site and 24 the bladder neck continence site.For purposes of full and enabling disclosure and ease of reference, FIG.4 further provides detail with respect to the positioning of pubic bone25, vaginal wall 26 and vaginal mucosa 28.

FIGS. 5 through 5B will further illustrate and disclose the slingtransfer instrument of the instant invention as well as its deploymentmethodologies with respect to transvaginal utilization. Turning now toFIGS. 5 through 5A. In FIGS. 5 through 5A it is seen where the slingtransfer instrument defines in part a progressively curved shaft portion51 positioned between distal 52 and proximal ends 53. An attached handle54 located at the shaft's proximal end 53. The sling transfer instrument50, attached handle 54 further comprises a digit control accommodation55 with said digit control accommodation dimensioned approximately 2.5to 4.5 cm in length, 1.0 to 4.0 cm in width and approximately 1.5 cm indepth. The progressively curved shaft portion 51 of the sling transferinstrument has a diameter of about 3.5 mm to about 4.0 mm and aprogressive curve with a maximum radius of approximately 5.1 cm. As canbe seen in FIG. 5, the distal end 52 of shaft portion 51 is oriented ina direction opposite that of said shaft's curved portion. The distal endof the shaft portion oriented in a direction opposite of the shaft'scurved portion is referred to as shaft tip portion and is approximately1.0 cm in length and approximately 4.0 mm in width at an end oppositethe end with handle 54 attached to shaft end portion 53.

FIG. 5B further illustrates a distal end of sling 7 which illustrates amesh portion comprised of non-absorbable polymers and filaments having adiameter from 0.002 inch to about 0.08 inch. Alternatively, the meshsling distal portion 7 may be comprised of absorbable polymers andfilaments with said filaments forming a mesh pattern having a diameterfrom about 0.12 inch to about 0.1 inch. As discussed in association withFIGS. 1 and 2, the mesh sling is approximately 1.0 cm wide at proximaland distal ends (proximal end not illustrated in FIG. 5B) and a centermost portion approximately 2.5 cm in length and 1.5 cm to 3.0 cm at itswidest and generally center most position.

As an alternative to transvaginal and suprapubic deployment, anobturator fossa sling transfer instrument may be used for thisparticular type of deployment methodology. An example of the exaggeratedcurvature distinguishing sling transfer instruments used in associationwith transvaginal deployment (as illustrated in FIGS. 5 through 5B),FIG. 6 illustrates the progressively curved portion of the obturatorfossa deployment embodiment wherein the progressively curved shaftportion 51 has a diameter from about 3.0 mm to about 4.5 mm and aprogressive curve with a maximum radius of approximately 5.0 cm. Distalportions of said shaft 52 and handle portion (not illustrated in FIG. 6)remain consistent with specifications disclosed in association withFIGS. 6, 6A, 10 and 11 of the parent application (Ser. No. 10/308,735).

Returning now to FIGS. 5 through 5B wherein the invention's deploymentmethodology for transvaginal practice is disclosed. With respect totransvaginal deployment, a sling of the type disclosed in detail inassociation with either FIG. 1 or 2 is provided with the sling definingin part a tissue remodeling portion and a mesh section and contoured tothe anatomical configuration of the mid-urethra, proximal urethra andbase of the bladder. A sling transfer instrument 50 is next providedhaving a distal end 52 and a proximal end 53 with a progressively curvedshaft portion 51 positioned between said distal 52 and proximal 53 endswith a detachable insertion handle 54 located at the instrument 50proximal end 53. The sling transfer instrument is positioned with thedetachable insertion handle 54 grasped within the human hand and usingthe handle 54, the instrument guides the distal tip portion 52 throughthe vaginal wall 60 behind the pubic bone 61, through the abdominal wall62 and exiting the abdominal wall 62 below the pubic hair line. Thedetachable insertion handle 54 is next disengaged from the proximal end53 of the sling transfer tool 50 after the sling transfer handle 57 isattached to the sling shaft curved tip 52. The distal end of sling 7 isnext attached to the sling transfer's proximal end 53. The handle soattached 57 is then positioned within the human hand and using saidhandle 57, the sling transfer shaft is retrieved or otherwise pulled ina motion to motivate the sling 7 attached to the instrument's proximalend 53 through the vaginal wall 60, behind the pubic bone 61, throughthe tissues of the abdominal wall 62, traversing the perforations madein the vaginal wall and abdominal wall made previously. A second slinginstrument is then inserted on a portion of the body sufficientlydistanced and positioned exactly on the opposite side of the body fromthe first sling transfer instrument with exact deployment stepscompleted to cause sling 7 to form a U-shape around mid-urethral andbladder neck sphincteric continence sites. Once so positioned, the slingis displaced from the sling transfer instrument subsequent to said slingproximal and distal end passage through the abdominal wall. Postposition sling tension may be further accommodated via a sling tensionmeasurement component that is discussed and disclosed in associationwith Parent application Ser. No. 10/308,735.

With respect to obturator fossa deployment, the procedure as describedin association with transvaginal deployment is utilized withdistinctions limited to the utilization of a progressively curved slingtransfer instrument, as discussed in association with FIG. 6, and anexiting of sling transfer instrument tip 53 at a point allowing the tip53 to exit through the obturator canal near the labia majora of thevagina instead of the suprapubic position.

With respect to the suprapubic method for treating urinary stressincontinence, a sling defining in part a tissue remodeling portion and amesh section contoured to the anatomical configuration of themid-urethra, proximal urethra and base of the bladder is provided. Saidsling consistent with discussion and disclosure previously described inassociation with FIGS. 1 and 2. A sling transfer instrument having adistal end and a proximal end with a progressively curved portionpositioned between said distal and proximal ends with an insertionhandle is located at the instrument's proximal end. The sling transfer'sinsertion handle is positioned with a human hand and utilizing thehandle, guides a curved tip at the instrument's distal end through theabdominal wall, through the retro pubic space allowing the tip of theinstrument to maintain contact with the posterior surface of the pubicbone as it traverses the retro pubic space and continues into thevagina. A second sling instrument is next provided and similarlytraverses through the abdominal wall, through the retro pubic spaceallowing the tip of the instrument to maintain contact with theposterior surface of the pubic bone as it traverses the retro pubicspace as it continues into the vagina. The second instrument so deployedis positioned and deployed in a manner to allow attaching of the slingdescribed in the parent application (Ser. No. 10/308,735) to be attachedto the distal ends of the sling instruments so deployed. Cystoscopy isperformed subsequent to the tip of both instruments being positioned inthe vagina. Having attached the sling to the distal ends of bothinstruments, both instruments are withdrawn or otherwise positioned insuch a manner to allow the distal ends of the sling transfer instrumentsto cause the attached sling to form a U-shape around the mid-urethraland bladder neck sphincteric continence sites. Once so positioned, thesling is displaced from both sling transfer instruments and slingtension adjustment may be facilitated by a sling tension measurementcomponent as deemed necessary.

FIGS. 7 and 8 illustrate alternative embodiments of the tubular sling ofthe instant invention as deployed in extended continence supportapplications.

FIG. 9 is an illustration of the sling tension tab of the instantinvention providing further detail to allow for proper sling tensionsubsequent to deployment and positioning.

FIG. 10 is an illustration of the sling tension adjustment handle of theinstant invention for increasing tension providing further detail toallow for proper sling tension subsequent to deployment and positioning.

The claims and specifications describe the invention presented and theterms that are employed in the claims draw their meaning from the use ofsuch terms in the specification. The same terms employed in the priorart may be broader in meaning than specifically employed herein.Whenever there is a question between the broader definition of suchterms used in the prior art and the more specific use of the termsherein, the more specific meaning is meant.

While this invention has been described to illustrative embodiments,this description is not to be construed in a limiting sense. Variousmodifications and combinations of the illustrative embodiments as wellas other embodiments will be apparent to those skilled in the art uponreferencing this disclosure. It is therefore intended that thisdisclosure encompass any such modifications or embodiments.

It will of course be understood that various changes may be made inform, details, arrangement and proportions of the apparatus withoutdeparting from the scope of the invention, which generally statedconsists of an apparatus capable of carrying out the objects above setforth, in the parts and combination of parts as disclosed and defined inthe appended claims.

1-8. (canceled)
 9. A surgical instrument for treating female urinarystress incontinence comprising: a) a sling contoured to the anatomicalconfiguration of the mid-urethra, proximal urethra, bladder neck andbase of the bladder for implanting into the abdomen of a femaleproviding support to mid-urethral and bladder neck sphinctericcontinence sites as well as support for the base of the bladder torestore the normal anatomical relationship of the urethra to thebladder, said sling defining in part a mesh section fixedly attached toand surrounding a tissue remodeling portion; and b) a sling transferinstrument having a distal end and a proximal end, said instrumentdefining in part a progressively curved shaft portion positioned betweendistal and proximal ends with a first detachable handle located at itsproximal end, a second attachable handle positioned said shaft's distalend, and a means for attaching said sling to the proximal end of saidshaft.
 10. The sling transfer instrument of claim 9 wherein said firsthandle further comprises a digit control accommodation, said digitaccommodation dimensioned approximately 2.5 to 4.5 cm length and 1.0 to4.0 cm in width and approximately 1.5 cm in depth.
 11. The mesh sling ofclaim 9 wherein said mesh portion is comprised of non-absorbablepolymers and filaments of said mesh have a diameter from about 0.002inch to about 0.08 inch.
 12. The mesh sling of claim 9 wherein said meshportion is comprised of absorbable polymers and filaments of said meshhave a diameter from about 0.012 inch to about 0.1 inch.
 13. The meshsling of claim 9 wherein said mesh center portion is approximately 4.0cm in length, approximately 2.5 cm at its widest and generally centermost position and approximately 1.0 cm wide at each of its oppositeends.
 14. The transfer instrument of claim 9 wherein said progressivelycurved shaft portion has a diameter form about 3.5 mm to about 4.0 mmand a progressive curve with a maximum radius of approximately 5.1 cm.15. The transfer instrument of claim 9 wherein said tip proximal end ofsaid shaft portion is oriented in a direction opposite that of saidshaft's curved portion, said proximal end of said shaft 1.0 cm in lengthand approximately 4.0 mm in width at an end opposite that end attachedto said shaft position.
 16. The transfer instrument of claim 9 whereinsaid progressively curved shaft portion has a diameter from about 3 mmto about 4.5 mm and a progressive curve with a maximum radius ofapproximately 4 cm.
 17. The transfer instrument of claim 9 wherein theprogressively curved shaft is further comprised of a luminous coating.18-19. (canceled)
 20. A transvaginal deployment method for treatingfemale urinary stress incontinence comprising: a) providing a slingdefining in part a tissue remodeling portion and a mesh section andcontoured to the anatomical configuration of the mid-urethra, proximalurethra and base of the bladder; b) providing a sling transferinstrument having a distal end and a proximal end with a progressivelycurved shaft portion positioned between said distal and proximal endswith a detachable insertion handle located at the instrument's proximalend; c) positioning the sling transfer instrument's detachable insertionhandle within the human hand and using said handle to guide the curvedtip at the instrument's distal end through the vaginal wall, behind thepubic bone, through the abdominal wall and exiting the abdominal wallbelow the pubic hair line; d) disengaging the detachable insertionhandle located at the instrument's proximal end from the progressivelycurved portion of sling transfer tool; e) attaching a sling transferhandle to the exited curved tip; f) attaching the sling of step (a) tothe sling transfer instrument's proximal end; g) positioning the slingtransfer instrument's sling transfer handle within the human hand andusing said handle to retrieve or otherwise pull the sling attached tothe instrument's proximal end through the vaginal wall, behind the pubicbone, through the tissues of the abdomen traversing perforations made inthe vaginal wall and abdominal wall previously in step (c); h) providinga second sling transfer instrument and repeating steps (c) through (g)on a side of the body to cause the sling to be positioned to form aU-shape around mid-urethral and bladder neck sphincteric continencesites; i) displacing said sling from the sling transfer instrumentsubsequent to said sling's passage through the abdominal wall.
 21. Themethod of claim 20 further comprising the adjusting of sling tension viaa spring loaded tension measurement component.